Investigations of Esophagoenteral Anastomoses by Manometry and pH-metry and Evaluation of Antireflux Reconstructions
There are more than 50 techniques applicable for preventing reflux in esophagoenteral anastomoses after total gastrectomy [1–3, 5]. However, a considerable number of patients with a so-called alkaline reflux result from most of the methods. More complicated procedures may also cause an insufficiency of two or more anastomoses (Table 1). Jejunoplication according to Siewert-Peiper [6, 7] or according to Schreiber  is said to fulfill the requirements: (1) prevention of reflux esophagitis, (2) inhibition of dumping; reservoir, and (3) safety and simplicity of technique. Of 48 patients with carcinoma (Fig. 1) operated on by gastrectomy, 29 were reexamined after 1 year with X-ray (special contrast medium), manometry (rapid pull-through method, three-point method), long-term pH-metry, endoscopy, and histology (Savary). Of these patients, two received an omega loop and six were reconstructed and modified according to Schreiber and 21 according to Siewert-Peiper. For three-point manometry, constant-flow perfusion was used with its pressure reservoir to ensure a valid reproduction of the pressure values. “Alkaline” reflux was defined to occur when a pH above 7 was recorded. Long-term pH-monitoring of the lower esophagus was established by a radiometer probe GK 282/C 5 cm above the anastomosis. Since there is only a small high-pressure zone in the site of anastomosis, it was established not only by manometry but also as the distance from the anastomosis to the incisors by endoscopy and/or radiologically. The patient was allowed to move freely in the upright and supine position. Severe reflux with a pH of more than 7.5 was reported as the percentage of the examination period. The number and duration of severe alkaline reflux episodes were also noted.
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